Document Detail


Warfarin anticoagulation after total hip or total knee replacement: clinical and resource-utilization outcomes in a university-based antithrombosis clinic.
MedLine Citation:
PMID:  23413165     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Clinical and resource-utilization outcomes associated with warfarin anticoagulation after major orthopedic surgery were evaluated.
METHODS: Consecutive patients who received postsurgical prophylaxis with warfarin within 24 hours of total knee replacement (TKR) or total hip replacement (THR) surgery and who were referred to and had outpatient follow-up for anticoagulation management in a single-center, university-based antithrombosis clinic from January 1, 1998, to January 1, 2009, were included in the study. Data were obtained from existing inpatient and outpatient medical records and retrospectively reviewed. Patient follow-up and data collection were conducted from the time of admission until 90 days after surgery.
RESULTS: A total of 400 patients were included in the study; 179 (44.8%) underwent THR and 221 (55.3%) underwent TKR. The mean length of hospital stay was 5.0 ± 1.9 days, and the mean length of warfarin therapy was 50 ± 21 days. The mean time required to reach the target International Normalized Ratio (INR) of 2.0-3.0 was 10.0 ± 9.1 days. The within-patient percentage of INR levels spent in the target range was 28% ± 18%. Objectively confirmed symptomatic venous thromboembolism (VTE) occurred in 16 patients (4%), with 14 events (87.5%) occurring with INR values of ≤2.0 and 2 events (12.5%) occurring with INR values of >2.0.
CONCLUSION: THR and TKR surgical patients at one institution who were receiving postsurgical VTE prophylaxis with warfarin spent a substantial proportion of time with their INR below the target range and had a high rate of symptomatic VTE.
Authors:
Edith A Nutescu; Adriana Bautista; Weihua Gao; William L Galanter; Glen T Schumock; Samir H Mody; Brahim K Bookhart; Bruce L Lambert
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists     Volume:  70     ISSN:  1535-2900     ISO Abbreviation:  Am J Health Syst Pharm     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-10-28     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  9503023     Medline TA:  Am J Health Syst Pharm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  423-30     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers / trends,  utilization
Adolescent
Adult
Aged
Ambulatory Care Facilities / trends*,  utilization
Anticoagulants / therapeutic use*
Arthroplasty, Replacement, Hip / trends*
Arthroplasty, Replacement, Knee / trends*
Cohort Studies
Female
Follow-Up Studies
Health Resources / trends*,  utilization
Humans
International Normalized Ratio / trends
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Venous Thromboembolism / epidemiology,  prevention & control
Warfarin / therapeutic use*
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 5Q7ZVV76EI/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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